Bascom Cleft Lift: The Modern Treatment for Pilonidal Disease

By Reza Rahbar, MD, FACS, FASCRS

Board-Certified Colon & Rectal SurgeonCarolina RHI | Cary, North Carolina

Pilonidal disease can be one of the most frustrating conditions we treat. Many patients come to our office after suffering through years of painful infections, repeated abscesses, drainage, antibiotics, and even previous surgeries that failed to solve the problem.

The good news is that treatment has evolved significantly. At Carolina RHI, we believe that most patients with chronic or recurrent pilonidal disease deserve more than simply having another “cyst removed.” Our preferred operation for appropriate patients is the Bascom Cleft Lift, an advanced reconstructive procedure that addresses the underlying cause of pilonidal disease while providing excellent healing rates, less pain, and a faster return to normal activities.

My Experience

I have devoted my career exclusively to colon and rectal surgery. After completing my General Surgery residency at Beth Israel Deaconess Medical Center, Harvard Medical School, I completed fellowship training in Colon and Rectal Surgery at Louisiana State University. I have spent my career treating diseases of the colon, rectum, and anus, including complex pilonidal disease.

Throughout my career, I have cared for patients with everything from simple pilonidal abscesses requiring drainage to complex recurrent disease after multiple failed operations. Every patient is different, and every operation should be tailored to the individual rather than relying on a one-size-fits-all approach.

At Carolina RHI, my goal is straightforward: provide the most effective treatment with the least disruption to your life while minimizing the chance that you will ever need another pilonidal operation.

What Is Pilonidal Disease?

Despite the name “pilonidal cyst,” this condition is usually not a true cyst.

Pilonidal disease develops within the crease between the buttocks (the natal cleft). Hair, friction, moisture, and pressure cause tiny pits to form in the skin. Hair becomes trapped beneath the surface, creating chronic inflammation that can eventually lead to infection.

Symptoms commonly include:

• Pain near the tailbone

• Swelling

• Drainage of blood or pus

• Recurrent abscesses

• Persistent openings or sinus tracts

• Difficulty sitting comfortably

Many patients experience repeated cycles of infection that temporarily improve with antibiotics, only to return weeks or months later.

Why Does It Keep Coming Back?

One of the biggest misconceptions about pilonidal disease is that the infection itself is the problem.

In reality, the deep gluteal cleft creates the perfect environment for disease to persist. Hair is repeatedly forced into the skin while moisture and friction prevent healing. Unless that anatomy is corrected, recurrence remains a possibility.

This is why simply removing infected tissue often fails to provide a permanent solution.

Traditional Surgery

Historically, surgeons treated pilonidal disease by widely excising the affected tissue and leaving the wound open to heal from the bottom up.

Although this removes diseased tissue, patients often experience:

• Large open wounds

• Weeks or months of dressing changes

• Daily wound packing

• Extended time away from work or school

• Significant discomfort

• Recurrence despite prolonged healing

Fortunately, modern surgery offers a better option for many patients.

What Is the Bascom Cleft Lift?

The Bascom Cleft Lift was developed by renowned surgeon Dr. John Bascom and has become one of the most successful operations for chronic and recurrent pilonidal disease.

Rather than simply removing tissue, the operation reconstructs the area by:

• Removing all diseased tissue

• Eliminating sinus tracts

• Flattening the deep natal cleft

• Moving the incision away from the midline

• Creating an environment where hair and moisture are far less likely to cause future problems

This approach treats the underlying cause of the disease—not just the infection.

Benefits of the Bascom Cleft Lift

Compared with traditional wide excision, patients often experience:

• Less postoperative pain

• Faster wound healing

• A closed incision instead of a large open wound

• Minimal wound care

• Earlier return to work, school, and athletics

• Excellent cosmetic results

• Low recurrence rates when performed by an experienced surgeon

Who Is a Candidate?

The Bascom Cleft Lift is an excellent option for patients with:

• Recurrent pilonidal disease

• Chronic drainage

• Multiple pits or sinus openings

• Previous failed pilonidal surgery

• Large or complex disease

• Persistent inflammation in the gluteal cleft

Many patients who have been told they simply need another excision may actually benefit more from a cleft lift.

What Is Recovery Like?

The procedure is performed on an outpatient basis, allowing most patients to return home the same day.

Following surgery, patients typically experience:

• Walking the day of surgery

• Mild to moderate discomfort for several days

• Showering within 24 to 48 hours

• Drain removal after approximately one week, if placed

• Return to desk work within one week or less

• Gradual return to unrestricted activity in just a few weeks

Recovery varies from patient to patient, and we provide detailed postoperative instructions to help ensure the best possible outcome.

Why Experience Matters

Although the Bascom Cleft Lift has excellent outcomes, it is technically more demanding than a standard excision.

Long-term success depends on careful patient selection, meticulous surgical technique, complete removal of diseased tissue, proper flap construction, and thoughtful postoperative care.

As a fellowship-trained colorectal surgeon, I routinely perform surgery in this region of the body and understand the unique anatomy and wound-healing challenges involved. My focus is not simply removing disease—it is providing durable healing while preserving comfort, function, and quality of life.

Why Choose Carolina RHI?

At Carolina RHI, patients receive care from a fellowship-trained colorectal surgeon with extensive experience in diseases of the colon, rectum, and anus.

Our philosophy is simple:

• Recommend surgery only when it is truly needed.

• Use the most effective, evidence-based techniques available.

• Minimize pain and recovery time.

• Reduce the likelihood of recurrence.

• Treat every patient with compassion, honesty, and respect.

Whether you are experiencing your first pilonidal abscess or have undergone multiple previous surgeries, we will work with you to develop a treatment plan that fits your condition and your goals.

Schedule a Consultation

Living with recurrent pilonidal disease is not something you simply have to accept.

If you have chronic drainage, repeated infections, persistent pain, or have been told you need another surgery, we invite you to schedule a consultation at Carolina RHI.

Together, we can determine whether the Bascom Cleft Lift is the right solution for you and help you get back to living your life with confidence.